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To apply this kind of rigor and approach to to to this disease and its outbreak, and you saw yesterday some of you will see this and I brought along again today because we get to the second question then of. OK, great. We understand the approach now and that took some time to understand it and understand how does it actually work at at, you know, each level. And that was another big learning. I'm interested in the differentiation apart. But what was interesting is as they went through this was that there was a lot of latitude, like the big rules of the game were in place.


But provinces, counties, you know, towns, they could adapted as they needed to be able to make it work for them. And so as you went from one to another, the fundamentals were always the same. You know, you're tracing contacts, not cats. Right? I mean, the fundamentals are the same, but they were adapted to be able to work for for four for that specific area.


By the way, someone asked me once, is that OK? We've seen the big cities, but what about the rural areas? What was happening there and what we're in Sichuan. We looked at that and this comes back to the technology part, went to the operation center and said, well, how is that working? And so they had teams out there all over the place that were doing their case. Fine investigations, contact tracing. But. Well, that's great.


But how do you know how it's working, et cetera? And they have standard indicators to trace all that stuff.


But they and they said, well, we made a decision in Chengdu right at the beginning. The governor explain this to me, that as we rolled out our 5G platform, we were not going to prioritize Chengdu. We were going to use this to make the connectivity with the rural areas work so we could run the covert response basically in real time. And so we were in one of these place. You went to the operations center and they'd had a new cluster and they had mapped out.


So they had one big screen on the wall that had the transmission chains mapped out and there was a problem with it. And I asked something about that and they said, we can speak to them. And they pulled up on the other side. The operations center in this county. And so we talk to them about what they're finding in the rest, which took a while. And then again, there was a question. So they said, well, hang on a minute.


And then they pulled up another screen. And there was the team that was out in the field actually trying to do this. But the whole thing is linked up and they're in constant contact trying to make sure that together they solve the problems of trying to sort out the transmission. So so the question then was, OK, well, what's the the the impact of this? Because there has been obviously this is happening elsewhere. There's exponential growth. And as I said yesterday, it's it's the, you know, unanimous assessment of the team that they have changed the course of this outbreak.


What was a you know, a rapidly escalating outbreak has plateaued and then come down faster than one would have expected if we had looked at the natural dynamics of an outbreak like this.


And and that's that's striking. And so what what it showed yesterday was was this graphic here, which I think is really helpful, because what you can see here is notwithstanding this report reporting, spite here. But what you're looking at here is, you know, what you what you call it, you know, exponential growth. Right. Growth rate here at the beginning of this curve going up like that. And if you look at this side, you can see it's actually coming down more slowly because what happens in normal?


What we have with an exponential growth, if you go up and up and up like that. And then you would see a normal distribution and it would come down like that. That's a normal. And you've seen these normal distributions. Right. That's what would happen if it runs through community. But when you started doing all of this, which are the interventions, then you can, you know, ideally try and change the shape of that.


And that's what China has actually done, to my surprise, as far as yet, it was one of those things that, you know, we spent 20, 30 years in this business. It's like seriously going to try and change that with those tactics. And yes, and it was successful or it is being successful because look where the cases are driven right now. And one of the things we looked at was, OK, well, is that curve would go like that.


You know, big question mark. How many cases have been prevented or at least delayed as a result of this action?


And, you know, rough back of the envelope. You know, we look at it. It's hundreds of thousands of people in China did not get covered, 19 because of this aggressive response. And any time you pull down the force of infection from the epicenter in an outbreak like that, you are going to reduce the problem. Bility of it going elsewhere as well. That was the other big thing we heard again and again from anyone in China was it's our responsibility to do this for the world, not just for it, for them.


We heard that quite a number of times. So the question then became OK, because we'd heard before getting there, of course, are the. Is this real? And, you know, one of the comments I made yesterday was we know the numbers have bounced around as they've gone down and people have asked questions. What's going on today? How come the numbers have gone up, et cetera. And you know what we as epidemiologists are interested in is not the exact number on an exact day.


We're interested in the trend. And you want to know, is that trend real? Is this going down? Is it stable or is it going up because the requestion is about things aren't being shared, et cetera. And so when we dug into that, we looked at, you know, multiple different there's multiple different ways you can try and get a sense of where the trend is going. And one thing you can do is you can talk to doctors who are seeing patients who are running these massive hospitals.


And, you know, everywhere you are hearing the same thing that, you know, we have open beds in Wuhan. It was like we have open beds. We can get people out of, you know, isolation centers and into a proper hospital bed. We're able to you know, the system is opening up because a number of cases are going down. You know, one indication another one we looked at was they've established what they call fever clinics.


And these are places where if you have a fever, you go and they assess you and they do a C.T. scan very quickly. They do that to see whether or not you've got the telltale marks of covert 19 disease and which is amazing story. And so but. And then and then at these fever hospitals and a decision is made, they do this test with whether or not you need tests. And then they do the test and then whether or not you need to be isolated in a facility, et cetera.


So the another thing we looked at, well, how many people are getting tested? Because what's happened is, as people have you know, this mobilization of the community has happened. There's been more and more people who want to be tested, quite frankly. And so they've been going and getting tested. The numbers have been going up and up and up. In terms of people getting tested initially, at one point it peaked at about I think forty six thousand people were being tested almost daily across the country.


Huge numbers and then is down. When we looked at about a week and a half ago, down to 13000 was going down like that. And when we went talk to the people at the fever clinic, you know, they were sitting there not scanning people or not testing people. And they said, you know, this is change. We had lines and they aren't there anymore. That's a second indicator that that is real. It's coming down. And then a third indicator, which was interesting, I spoke to and again, I mentioned this yesterday, so sorry to be redundant, a fantastic researcher, a man called Chow Bean who is running a REM, deserve your trial.


Severe and mild cases in Rouhani. And it's being done. And Rouhani, of course, because that's where he have the highest number of cases.


You get the fastest enrollment and we try and get an answer on this interesting drug as quickly as possible. And so when I was talking to him, I said, so how is enrollment going? And he said, it's a challenge. It's slowing down. It has slowed down because there are not enough new patients that we can actually recruit into the trial. So, you know, this all comes back to that question of, is this real? Is what I described, you know, this extraordinary mobilization to implement fundamental public health principles and approach in the absence of a vaccine or a or drugs, you know, in the presence of a respiratory disease.


Can this bring this down? And it can. And that's the core message right where we're we're getting new reports daily of new outbreaks and new areas and people a sense of, oh, we can't do anything. And people are arguing, is it a pandemic or not? Sorry. Why don't you go look at. Have you got 100 beds where you can isolate people if you have to? Have you got a wing of a hospital that you're going to close off?


Have you got 30 ventilators? Because you're gonna have to help keep the severe cases alive for, you know, they'll recover, but they're going to need to be ventilated for four or five days or a week. Do you have those pieces? Do you know who your thousand case contacts racers are? There's really practical things you can do to be ready to be able to respond to this. And that's where the focus will need to be. So we looked at this and said, OK.


The first question I told about what was done, the second, what was the impact and the impact it was was striking. Oh, I showed yesterday another graphic, which might just be useful for people because in some ways this is more striking than the national one. So what you see here, this is the same as when you. You saw these are the data for all of China. Right. So going up fast, fast, fast like that up abrupt plateau and then the skewing as it goes down rather than up like that, a bell curve and down out like this.


But then if you look at and you can see this is this is right here, which was really driving the main shape of that, then these are the other areas of Hubei. And this is China outside of Hubei. And remember, there's a lot more people who live outside of the province of Hubei than live in Hubei. But this is a much smaller curve, number one. The other thing, the shape, it's a very flat curve as well.


Part of it's a scale, but this is not the shape of a normal epidemic.


And that happens when you do something to try and change it, which is what China has managed to do. And what's striking is how far down they've gotten it. If I remember yesterday, someone told me that I've heard so many figures. I think I've heard more figures than there are people in China over the last two weeks. But I think one of the figures I heard yesterday was that zero out of twenty three twenty four provinces had reported zero cases for a day.


And that's remember, there were 31 provinces affected only only three weeks ago. Again, the evidence and all of these are as big as any one of the countries that have been, you know, in the news recently with their outbreaks. And that's a very hopeful thing. Which brings us to the third thing that we're looking at is, OK, where do you go next with China? Where do you go next with the with this in terms of of of the global response?


And one thing you mentioned first is that, you know, China, we're not acting from scratch. China had had the Saras epidemic, an outbreak, rather, remember in 2003, and they realized they had to set up surveillance for a typical ammonia gas and other surveillance systems that they needed to be able to do. Case finding and contact tracing, you know, at a much larger scale, etc. So they had had time and experience to build a system.


But in terms of where they go next in China and you know, having seen so much of what they had done, it was a little bit humbling to be asked for opinions. Okay. Where we go next. And a lot of it was really reinforcing what China is already doing. And the first piece of it is, you know, the vigilance cases are down, but they're not zero. There is still a lot of disease in the country that that's got to be dealt with.


And remember, the people who get sick, they remain in hospital or in a in an isolation center for anywhere from two to six weeks. So it's a long period of time.


So if you have all of these people that got it, let's use this. If you have all of these people, let's go back a few weeks. So if we go back two or three weeks. Right. So you're back here. If you have all of these people that were sick at that time, and you've got to add some of the ones who are sick, because that's just who are sick on that day or that week, remember? So then you got to have the ones before.


So an awful lot of those people are still in hospital or holding center or holding center premie, you know, an isolation center.


So right now, the number, if I remember correctly yesterday was it was just over 50000 people are still recovering from Cauvin, 19 across across China. But what one of the other things we learned, though, is the spectrum of the disease. Those have been a lot of question about, OK, what is really the spectrum of disease that this causes? What's the natural history of that? We got a lot of information there because of just the sheer numbers now.


And as the epidemic or the outbreak goes forward and they start to get control, there's time to analyze a lot of that information more clearly. So now they can generate. And this I take absolutely no credit for this. This nice piece of work. But this was done by the Centers for Disease Control for the report. And what they've done here is try to help people be able to visualize, well, what proportion are mild or common when when they're when they're found.


What proportion are severe and what proportion are critical, critically ill patients. And I think you have a sense now that the mild cases may just have a fever and a cough, an ad. And this by the time you get to the common, they usually have a pneumonia and they're a bit sicker. But frankly, they're still mobile and in good shape. The severe are the ones by the simplest way to say that is the next step, as they usually have respiratory insufficiency of some sort, like their oxygen saturation is going down, their breathing rate is going up at.


Cetera. And then the criticals usually have by then often multi-organ failure. And what we are able to see from this is, OK, what proportion fall into each group and you can see 80 percent are mild. And of those in a really important insight from Dinah's, well, how many of those will go on to severe disease or even death? And you can see from the milds in the Commons, very small proportion. This is really mild pneumonia with severe alarger in the worst outcomes, of course, in the critical.


But now we're getting to the sheer weight of numbers that help us understand that that's really important because you've got to plan. How many beds might you need? How long are you going to need them for? One of the outcomes gonna be like how many are going to become severe and you're going to need possibly ventilation, etc. These are really important things to be able to plan that. Also, if you want to plan a clinical trial, you need to understand, well, would they get worse without the drug or not?


Would they go for it? So you need this kind of information is is so important. And China right now are the only ones who have been able to generate with the kind of numbers to be able to to help us on under understand that. But what it means is they still have 50000 cases, as we mentioned. The thing is, any new cases now, they generally know where they've come from. They can link them epidemiologically or link them to a contact.


And that's when, you know, as you heard from a borehole, that that's when, you know, you're getting control of a situation. You're not getting cases from out of the blue and you can't link them back, which is is is what's sometimes so concerning. So that's the first thing. The second big thing, which is a really important message from China, is every governor we talk to, you know, that most of them, they had an epidemic curve was going down like that.


And what were they doing in response? Building hospital beds, buying ventilators and being prepared, that's what they were doing. They were saying, OK, look, we just repurposed hospitals that are should be giving general care if these cases go back up again. And that was always what they came back to. We don't know this virus. People are talking about SaaS or they're talking about flu. And as soon as we get stuck with those that two binary approaches and ways of thinking, we're not preparing for the novel Corona virus.


We're comparing preparing for that or preparing for this. But we're not using all the evidence that we have. And one of their key points they made again and again was we don't know what's going to happen next in China. We've got it right down like this. We think we can manage and there will not be another route. We know how to manage this disease now. And all the parts of the country, if it went to zero, disappeared, that'd be great.


But that's not what they're planning for. What they're planning for is this could remain for some time, maybe some time to lose a vaccine. So we will have the capacities to be able to manage it and run society and economy and everything else the way we need to and not lock people down to try and and manage this. That's the second big thing they're doing is a good message for the world. Right. How many countries are you planning? Hospital beds, planning ventilators, planning, you know, O2 supplies and the lab capacity to be able to manage this.


And then the third thing that he read we said and asked of China, at this point, the world needs the experience of China. And China has dealt with the most disease in the world. 31 provinces have managed this. Everyone we spoke to, they knew what they were doing and they've clinically managed huge numbers of cases now. And one of the points you heard me mentioned yesterday is countries are building barriers between themselves and China and new barriers are going up in the last days at a time when the cases and the risk from China are going down.


And you need access to that expertise that much more. You also need China and it's getting its productivity going, as you've heard. They're getting they're doing a phased restart of everything. So they're getting the, you know, the factories going. Then eventually they'll they'll get the schools going and then they'll but they're taking a phased approach to try and manage the the the startup now as they go forward. So for China, there were a number of suggestions about how to move forward.


And a lot of it was reinforcing some things that were already happening. But then for the rest of the world that were those were the bigger things that you heard me speak about yesterday, perhaps. But the first thing in the responses, there has to be a shift in mindsets again around the world. People are thinking, oh, gosh, how do we live with this and manage all this disaster, et cetera, instead of, gosh, this virus has got to come.


It's going to show up in our country. We're going to find it within the first week. We're going to find every case. We're going to go after every contact. We are going to make sure that we can isolate them and keep these people alive so they survive the case. This is the way we've got to be thing. It takes a real shift in mindset and it's not a preparedness mindset. We usually thinks about how you prepare for eventual disasters.


This is going to come soon, potentially. You've got to be shifting to a readiness, rapid response thinking. And, you know, in China, one of the interesting things was not only did they designate a whole hospital and these are big modern facilities, hundreds of beds as, OK, that was going to manage it. When you want and think, OK, how do you actually do that in practice? How do you keep it safe? So you go to award.


You know, if you go to hoog here to tour, I'm sure most of you have unfortunately had a visit one of those places. You know, you've got your own wards, right, with some doors at the beginning of the ward. Well, what what China's done rather than have some beds that are isolation beds, is that the start of that ward? They've built a wall with a window on it. They sealed the whole thing and said the whole ward.


Oh, that whole 40 beds. Hundred beds is now an isolation unit. It's just everything at scale very, very fast. They've taken a stadium move, which which I saw. They put a thousand beds up 72 hours. It's you've seen these hospitals being built over a week, but they went from they would convert a training center or a stadium in between 24 and 72 hours. That was the timeframe they took him to hand to increase by a thousand.


Their capacity and it was it was such a disciplined approach to put put that in place. But again, a good lesson. It's OK. We're going to try and not have to deal with two hands, obviously, but you may have to deal with sporadic cases, definitely. We're seeing that in many places they get sporadic cases. We're also seeing clusters of cases. And as soon as you start seeing that in places, you have to be ready to manage this at a larger scale.


You have to be ready in your mind to stop the transmission change. Have to be thinking that way. And so there has to be the mindset shift, number one. And there's got to be the readiness planning and capacity building. And it has to be done fast. So yesterday when I said, you know, second big conclusion for the world is it's simply not ready. But it could get ready very fast. But the big shift is got to be in the mindset about what we're going to how we're going to manage the disease.


The third big thing, you know, the rest of the world and probably this is the first one, is you've got to get your population ready and bring your population with you and your populations. You know, they should be washing their hands now. They should be proper, you know, hygiene. Now, those things that we should be doing anyway should be at scale in countries because they will make a difference to the spread of a respiratory borne disease.


But you've got to bring your population with you and your population. You want to bring them with you early because things are going to change rapidly and they are to have a trust in a way and a machinery to keep people up to date. Yes, we said that we have new information. Now, we do it this way because we have known this virus for seven weeks. So we are going to have to adapt as we get the the the strategy rolled out.


And the you know, the fourth thing I would say if we look at, OK, the rest of the world would be access the expertise of China and the you know, they've done this at scale. They know what they're doing and the really, really good at it. And they're really keen to help, even though they are still working in their own areas. And this was another message that you heard all the time in China. It was a fantastic story of the human side.


It was always about the people and the individuals. Everywhere you went front firm from any anyone you spoke to, and there was a sense of responsibility and silence, sense of, you know, collective action and this war footing and to to get things done. But the the other thing that was striking was the solidarity between provinces, because remember, every province in in China has been hit by an unknown pathogen that started to do this in the province. Their response was to get on top of in their own provinces, but to send medical teams, PPE, everything into.


And, you know, I met with the governors. They said, yeah, we just sent 2000 people into Suhan and to to to to work. And you wonder, how does that even work? Right. So you go to the stadium as a. How does that work? And the you know, one of the physicians says, well, I'm from and from from here on or one down, wherever it was. And he says, we run that.


You know, that one I told you that was boarded off. We run that one. They just bring a whole team and run the whole thing. And they bring all their own PPE, all their own equipment. They pull it out of that province. And remember, what we're seeing in the rest of the world is we better build up our stocks and keep it over here. Oh, we better keep this here. We better keep our whatever.


But there's this sense of you get the resources where they're needed. It's in our common interest to get this down. And you saw all the provinces operating that way. It was really fascinating. So those are the big findings. You know what China did? The real impact that it had. The implications are you can actually affect the course of this disease. You can change the shape of this. But it takes a very aggressive and tough program. It.


It was a striking thing to see. As you know, in 30 years of doing this business, I have not seen this before and nor was I sure it would work. So we did we saw a bunch of other things as well. As I mentioned, there were a number of technical things that we learned about disease severity and the natural history of disease, how it's transmitted, by the way, it evens some of the work being done on the AMA large and very interesting.


But then also operationally, how do you run a response like that? Right. Talking that through with top leaders. How do you set up a stadium in, you know, 72 hours and walk through? You do. One, two, three, four. I mean, it makes sense.


And then and then how you run these kind of containment measures that at this scale. So a lot of really good learnings that will inform other parts of what we're trying to do with this with this response. I would say let me one point, because I know there'd be questions and I'll. Stay as long as we need to try and help with any of those. But one of the big questions that we keep hearing about and you will have heard is about, you know, how much transmission is going on in communities.


Right. You keep hearing the tip of the iceberg and we can't see this thing. And, you know, there's millions people infected and all this kind of stuff. So we tried to look at those kind of questions as well.


And we again, you know, you're you're at war here and there's a huge fog in any war. You're trying to find those little bits of information that can add up and give you some confidence in what you're saying. So we tried to look at what.


Where was their sampling of people in the population that might give us a sense of how widely this virus was, was was was was spreading. And again, this is where it's great to look at these things in China because the numbers are so big. But you've probably heard there's something called an influenza like illness surveillance system that runs around the world with many sentinel sites that collect like 20 samples every month and get them analyzed, etc. But this happens in multiple places of China.


And what you could do is look at those data and they could show you here or a data sampling. Here's all the flu cases that were coming up in November, December of last year. They all went back to look, nobody. Because then once we had a COVA 19 tests and went back to test all of these, nobody found it. It wasn't there. They found lots of flu. But then in January, they did find it. It comes up in January.


The first couple of weeks of January. But outside of Hubei, very rare. What might be positive here when there wasn't like all these samples were were positive, like there was a lot of it circulating.


And then another thing we did is in places that were heavily infected, more and more people were coming to fever clinics. They wanted to get tested, et cetera. And in one place in many in Guangdong, I think they had tested three hundred and twenty thousand samples for code. The Colvard virus, 320000. Right. Going to give you some sense of what's going on.


And when they started the sampling of those about point four, nine, I think it was percent of more positive. So less than half a percent. And in the recent period, it's something like zero point zero two percent. So I know everybody's been out there saying, well, all of this thing is spreading everywhere and we just can't see it. Tip of the iceberg. But the data that we do have don't support that. What it supports is, sure, there may be a few asymptomatic cases and that probably is a real issue, but there's not a huge transmission beyond what you can actually see clinically.


And that's really important, right? If you're in a war, you need to be able to see your enemy to know what you're dealing with. Now, another important development, China. Just while we were there. Was it just licensed? A couple of zero assays that will let them test antibodies in a whole bunch of people to try and get a sense of if they have antibodies, but they weren't sick. You know, the virus was circulating.


So, you know, maybe I'll be sitting here next week. And, hey, guess what? Those data didn't tell us the story these ones do. But that Sero survey should help us understand that. And that'll be important. For example, you want to reopen your schools, you know that kids have not gotten very sick or very few have had a lot of them been infected. Are they part of the driver of this outbreak? It doesn't look like it looks like the main driver is not widespread community infection.


Looks like it's household level infection. That may be part of the reason that China's strategy find the case, because the close contacts are families and people. Usually, Noam, and you're gonna be able to find them and be more successful. And remember, you don't find every single one because you never will. You want to find enough to break the big chains of transmission, slow this thing down and get a grip on it.


So that's why we went what we saw was being done, the impact that we believe it had and we think it can inform the global response. I want to highlight again, I am not speaking for W.H.O. because, you know, someone may be going what?


But. But that's what the evidence says. And, you know, when you're in a war like this, this is. We had a big debate with some of our Chinese colleagues about, you know, is this a dangerous virus? Is a serious virus is whatever. The bottom line is, this virus kills people. You've seen that and it kills vulnerable people. It kills our elderly. And you know, what we think of a society is how we care for the vulnerable in our population is not jazz.


And I hear people say, oh, yeah, but the young survival's good. No, seriously. And it is. And that's not always the case either. Young people do die of this disease, as you've seen as well, and they die in industrialized countries. And I think people were also looking sometimes at this and saying, oh, but in China, you know, they don't have this, they don't have that, etc. You know, if I covered 19, I want to be treated in China.


You know, we'd go into these hospitals and, you know, how many ventilators do you have? 50, 60. I mean, just a scale. We're not used to thinking on the rest. And then you'd ask, you know, how many exmo systems you have. And I was like, here for you and ask about exmo. You know, there's an extra corporeal membrane oxygenation and it's two to when the lungs simply even if you ventilator and couldn't get enough oxygen and Paice would say five.


And I remember being with Tim from the Robert Koc Institute, like five in one hospital. You know, we don't have that in Europe and we're using three of them, too. And as in we were like, well, do they people come on. Yeah. So when we look at how dangerous this disease is as well, I think we have to be careful looking at the China data because China know how to keep people alive from Kove it.


They're super committed to it and they're making a massive investment in it as well. That's not going to be the case everywhere in the world. And as you've seen, we've had tragically lost people in, you know, G7 countries are dying of this disease. And so it is a serious disease. And and I worry sometimes if we look at the China numbers, people are going to get a false sense of security. These people know and they care about keeping these people alive.


And they do it successfully. They're really good at it. Folks, that's what we saw. Well, Herb, what we think can help inform the global response is never black and white. But sometimes we'll present our reporting's a little bit more black and white in hopes that will drive the discussion about where we go next with the global response. So, Margaret, no one looks interesting.


So they look solid. They said they're all hiring to go down.


I think lots you got to know Bernard schwerdtfeger, the chef de cabinet here. And he said, let's try and add up how much many hours you slept in the last 14 days and it barely gets into the double digits. So, again, sorry to run all this along, but we saw a lot and it's a complicated story. So I wanted to make sure you heard it before. I hear. But it be helpful to clarify. Thank you very much, Doctor.


And what I'd like to be treated. I'll star 9 and or if you'll using Zoom. Put your hand up on the icon, on the screen, on your right. We'll start with questions from the room.


Try to choose two.


She's gonna take from a question from. I also want to thank those of you who tried to contact me. I saw Jamie's hand went up first. Good people phone and called me in China and rest and those who know me running many crises. I tried to be extremely available to the press because I just think you're so important to manage a crises. It's in my interest. And in this occasion we went to a complete blackout because we really had to focus on this where we were.


We were trying to inform a global response and a danger of escalating disease. And, you know, people would make might call and say, well, this happened there, that happened there. You know, it gets you off track. We just had to focus on what we were doing. So. So thanks for the patience for those of you who are frustrated by that.


Okay. I'm going to be very geometric. We've got four microphones. One, two, three, four.


So I'll take a question over here from the correspondent from CGT and add on a parable about something.


Thank you, Shane from China Central Television CCTV. I have a question that is about you mentioned China has been successful in containing the virus and the disease. It's being yeah, it's it's showing success. Let's not put the cart before. They're not putting the cart before the horse. If they said I said they're contained the disease that ever fit because that that they. Yeah.


Thanks for being precise and fair. Sorry. So my question is, this would suggest that there are many things other countries can do from China. However, do you think there would be some difficulty for them to accept and thought all these measures? That's why they have such difficulties. Thank you.


Yeah, I'm going to jump in on the questions. It's a little bit like I said, right. This is a respiratory borne pathogen. And when we think about things like flu and the rest, we think, OK, we need a vaccine to manage that because you can't get ahead of the transmission of it. So part of it's a mindset shift that, gosh, this can actually slow this thing down. And frankly, I think the mindset shift is is the hardest part.


It's really hard work, too, right. Of take a vaccine, someone's arm really hard, find every single case and you got to find him super fast and get, you know, find every contact, get them isolated. So there's going to be a range of challenges. What is going to be that mindset shift? The second is the communities and populations coming with it, because to accept quarantine to where where it's needed to accept, you know, the rapid isolation, etc.


, you know, these are going to be challenges for for people as well and materially. Right. Have we. Are we ready to isolate that number of people, to support that number of people, et cetera? So there's a combination of of of, you know, mindset issues. Yeah, I think community engagement issues and just material issues. But we've got to overcome it. It's as simple as that.


And you think it's necessary because right now, except I think it's a good way works. And so that's that's why China is so so so let me say a word about that.


You know, with Ebola, we have a vaccine. Right. But it's not going to replace case finding, contact tracing. I don't know if the vaccine for this might look like, you know, we have Saras, we have Murs. We don't have vaccines that we've got great candidates, but they're not out there working there. Corona virus is right. And remember, those are the six human Corona virus. Right now there's those two and then there's the four that caused common colds and things like you've heard about.


We're not great at Corona virus vaccines. I mean, the whole world of people in the world of Corona virus vaccine a slaughter me because they're going to say we are great. We're just not using them. But we don't have the experience we do with flu, with other other other diseases. So, you know, and China's very pragmatic. Dunno if we're gonna get it. We're gonna work on it, but we're gonna move this way. That's what you heard again and again.


So sorry.


Let's take another question from Stephanie. Yes. It's been two years. I can't remember which agency I'm sorry. Right. Right. I wonder if I could draw you, please. Infections among health care workers. Sure. What you're seeing in hospitals and provinces. Have they. Do they have two parts? Do they have enough equipment and the training? And then we are the. Are you seeing transmission still in health care settings? There was a peak in January.


But given the scale of three super important questions Stephanie asked about health care workers.


Right. Because if your health system goes down, you can't run your response. Early days of Ebola in West Africa. It was one of the big, big challenges we had. And it's a common thing when emerging disease. Nobody knows. Right. Hits the help. You know, it enters through the health care system. Remember, that's where a virus is going to enter often cause they come in looking for care and and all of a sudden, boom, it blows up.


And if I remember correctly, Italy had had a had a had an issue. So with that. So in terms of China, first on the numbers of health care workers. And this is a rough. We always have to be careful and differentiate health care worker infections from nosocomial outbreaks. So a nosocomial outbreak is an outbreak in a health care facility. Right. And that can be patients, in fact, and health care workers, patients infecting other patients.


I mean, there can be different ways it works. When you look at health care workers, people often think, oh, that's an outbreak there. Most health care workers got infected in the community, not in the health care workers who get in there. And you talk to people who actually did that. And they can tell you, they say, well, no, they know. People often knew where they got infected. And the ones that are in the press and rightfully so, are ones where it all may have happened in the health care facility.


But the majority hadn't. So there had to be a two pronged approach to this. First was making sure that you run your covered facilities safe and frankly, that that was what was being addressed relatively early on.


But then remember, I told you so. That's your covert hospital, right? And this is your hospital for regular care. OK. So I'm pregnant. Don't feel great. I'll go into the regular care hospital or I've, you know, had had chest pain and I'm having probably breathing. I'll go there and you go into the regular hospital and you've got in fact, you've got covered. And so a number of the ones that were happening were actually happening not in the covered facilities, but they were happening in in in the regular facilities.


You know, Stephanie. So. So the first thing you always have to do in these is try to figure out who's getting infected, how are they getting infected, where are they getting infected? And then and then try and fix it. And yet again, everywhere we went, this was a top priority. And when you went in and looked at, OK, how are you managing infection prevention draw? You know all the basics about Clean Channel's dirty channels.


You know, we're in place. The supplies now largely in place. Yeah. We never found anywhere in there. There may still be some that where people did say it was really tight and there were periods where this was a real problem. But again, when you look at the distribution of the health care worker infections, most of them were much earlier in the outbreak. And that's the other thing. That's what we're seeing. I mean, you've seen in the countries that get re-infected boom, you get these outbreaks because they're not used to dealing with with the disease.


But they taking it seriously. Absolutely. Are they good at it? Absolutely. Are there numbers coming down? Absolutely. In terms of health care worker infections? That's a good news story within it. But it also highlights something that's a little bit different because, again, we think SA's flu. Right. But this is a doesn't cause we haven't seen big nosocomial outbreaks like we have with the other diseases. Right. So so something is a bit different.


We know we're not seeing a lot of disease in kids. You know, look at flu. You know, all the kids get sick. We're. Which is a problem because remember, one of the big problems with flu, all the kids get sick and then all parents have to stay home and then you lose billions of dollars and you know you from your economy, that that's how it works. That doesn't happen with this disease. And we never by the way, when we talk to people, we couldn't find an example where a child was the index case in a transmission chain or had, you know, led to the infection of an adult.


Now, that might just be people's recall or bias or whatever. But it was an interesting insight because remember, a lot of things that we test in science, it comes from someone's observation. And then you say, OK. Is that why? Is that so? Did I cover that? Well, now, Stephanie, I'm sorry, I'm kind of rambling because it's such an important issue.


Yeah, yeah. I mean, one other thing, Nugget. So we're in Suhan and we couldn't go into the fever clinic because you put yourself at risk. I was gonna come talk to you guys. And I was going gonna put my family at risk. There's no need to. But anyway, the. But we could see where they started and went in and got gowned and the rest to go in. And we met this woman there who explained the different stages and the mirrors for how they check the gown properly, etc.


. And she really knew she would. She is so impressive. And so I said, so you're like an ipsc expert. She's like, no. Guys, I do something completely different. But I've learned all of this stuff. This the most important part of what we do. You know, you found this passion everywhere. So, you know, Stephanie, that was important because you wonder, are people getting sent into the line of fire right away without the proper equipment?


And early in this, people were caught in a war without the right equipment. That that's kind of what sounds like it happened. But then you know that because if you were coming in from another province, you had to bring all your PPE. So, you know, these guys, it's sending a team from, you know, me or one of these other provinces. They came with tons of equipment. They had to be self-sufficient. And that was one of the issues with me going in there.


And I was told that said, look, we have a principle. No one goes in without the wrong gear. And fortunately, botter brought a bunch of gear, which was all sitting in Beijing and which I told our rep on the phone. Guess what? That's called going to the ministry tomorrow. But that that's how it worked. You found that discipline and everything. Sorry.


Okay. We'll take one more from this side. Gentleman there with his hand up.


Yes, go ahead. He's young. His Shanghai news agency, which once very young, was seen by news agency with a with grid efforts to get to the control and to prevent to the control prevention of the disease. China's also trying to resume the economic activities. So it's like a large number of people go back to the places to to where they work. So is there any special aspects or any parts that people should pay special attention to when they go back to work and resume the active economic activities?


And again, the question Yao's asking, so important, right? So you get this thing under control, then you get massive numbers of people moving again because remember, they've all been stopped. Right. And then they carry the virus into these areas. So a couple of things have changed, right? Number one, these areas are prepared. They know how to deal with this disease when it springs up, et cetera. The second is, is that they've done a phased reopening of of the factories, the industries, etc.


And in phasing that, they've been able to manage the risk as as they've opened. More and more of the economy tends a little bit on the province because most of them have done it a little bit differently. So some went, you know, like the week on 8 February, I think it was others went the following week. So so it's been rolled out temporarily, a little bit different as well. But the other thing that they've done and this was interesting in Sichuan when we met with the governor, he said, look, can we show you a video?


And he said, this is really cool. And sure, we will look at everything. And he showed this video that they'd made. And again, all of the migrant workers. What it did was it was it was this video you play on your phone and it gave you all this information. If you're a migrant worker from Sichuan and you want to go back somewhere, you have got to do X, Y and Z and go to one of these facilities, get screened, you will get a certificate that's valid for three days and you show up at the next city and then you will have to show that it can be scanned and uploaded, etc.


But there's a whole effort to manage it. You know, at the community population level, but also at the individual level. And they have five million people, migrant workers that they were going to run through the system. That was one province. So it is a risk to it. And they know it's a risk. But the economy's got to work. Its people have got to work. Life's not life's got to go on. It's got to power the response as well.


OK, I'm going to go online now and ask Helen branswell. She can have her quick.


Hey, how are you? Hi, Bruce.


How are you? I'm getting out. But I would ask you right off the top why you're not wearing a mask, if you don't mind. But I would also ask you to go in to what you were saying about not finding much undetected mild cases. A bunch of us were hoping that there would be more of the iceberg to be uncovered to drive down the severity of this outbreak. And I think you're suggesting that that is not true. No, no.


Yeah, I got your point through the echo. Yeah. So, so, so so first, don't don't miss. Miss. Misquote me, please. The this is a serious disease. There's a lot of disease. When you get a lot of community transmission going on, you know, tens of thousands of cases in this place. So that's a lot. But what I've heard people say is there's a whole bunch more of transmission. There's not a lot of evidence of that.


Now we're do serologic cerveza 0 asay, and we may find that a lot more people were positive, a lot more people were affected than we thought. Because remember, with flu, right, it's 10, 20, 30, 40 percent of the population will have may have antibodies suggesting that that they've been exposed in in a flu season. I'm not a few experts, so. So if I got the numbers wrong, but they're quite high. All of the sources of information that we looked at, Helen, like, for example, we were very, very interested in any kind of sampling that had been done at a population level and in multiple provinces we could find.


OK, we've sampled, you know, ten thousand people or we've sampled 50000 people in in in, let's say a just regular hospital clinics or something like that.


So this is convenient sampling, right. Is not a study. But in those they were finding a very low proportion of people actually had the virus. Now, there could be reasons for that, right. Because people are really restricted to their homes. They've, you know, closed restaurants, closed cinemas, et cetera, et cetera. There's all those things, which means, you know, the goal was to break that transmission. So but as things resume, that that's going to be a really important thing to look at.


But for that to happen now and remember, they would have to be a whole lot of mild cases that you wouldn't find. And in wewe, hon. Now, you know, these people don't want any more transmission. They want everybody isolate and break the transmission change and they're going house to house to check temperatures, et cetera. They're probably not missing, you know, a huge, huge amount, but not definite orders of magnitude. And then with, you know, asymptomatic again, it doesn't look like that's a big part of the picture.


There was just no data that supports that.


So, you know, I have to make a judgment. You know, Helen, between what are the data that I have? And one of the speculations that I can make and in worst case scenarios and the data doesn't say that it's a data we have. I may be wrong as we generate more data. But but, you know, all the data that we have suggests that there isn't this massive. The iceberg is, you know, you've got critical cases yet severe cases.


You got mild cases and a bit asymptomatic transmission probably at the bottom. That seems to be what it looks like.


But remember, we've known this disease for seven days, seven weeks. Sorry, I haven't slept in seven days.


I feel sick. Right. How does that help? We can go into Jason's going home, Jason going, but also, by the way. Would you be able to do that to the curve if this thing was going around everywhere like that and you couldn't see it? Hard to believe.


And so I have to go with what I can see.


OK, I will go into Jason Gale.


She asked why wasn't wearing a mask? Oh, sorry, sorry, sorry. Yeah. I don't have Cauvin 19. I'm very low risk. I did.


And, you know, I had an hour long grilling before I did this when I came back.


Anyone coming back from travel has to on the W.H.O. side. But also, I never had any exposures. You know, we were we are careful and we run careful. You know, we had no contact with patients. We have no contact with court direct, you know, close contacts with no contacts with contacts. We wash our hands every three seconds. We wore masks all the time because we had to wear masks. It's the government policy in the country.


We're social distance. We were you know, I told you, we're on trains and cars and everything. One person in a row. Everywhere. That's why I'm so hoarse, because it gives a shout at everybody. When we had meals, our meals were eaten in the hotel rooms. We weren't all the restaurants were closed, so we weren't even interacting with our group.


And then when we sometimes there we were, we were working and we would we'd like we went to the CDC was between meetings who went to CDC cafeteria for lunch? They had a table like this and then another table like this. One person at a table knows one setting at each table. And you weren't allowed to sit. You had to shout at each other. And then I told you the last day we were having weird last couple of days we were working on the report.


So, Margaret, to be on that table, you'd be out on one table. You on the next table. And we had to use microphones to run the meeting. But everything was distance two meters apart. And it runs that way there. And, you know, any of the hospitals we went to, we go into the clean section. And we were nowhere near, you know, there's a dirty section. And then there's also a gray zone.


You go, Noomi, near those things and give some other examples, because I had to go right through all of this. And then because I was going out through Beijing to do the press conference and Beijing, as you know, you'd ask you, how about people returning to work? Beijing put in place a policy. Anyone coming back from any province is automatically in a two week quarantine in Beijing. And that applies to us as well, unless we're in transit on the on the way on the way out.


And so what they said is a lot of negotiation about this. When I got off the train from Suhan and do Wandong, I had a swab yesterday and they said, you know, we will we will test you been in the country for two weeks. You're coming through Beijing. No shit. Negotiate agreement for how we manage this. And it was negative. But, you know, it comes back to a science and evidence based approach to to what we're doing if the evidence changes.


Right. And there any reason that I was at risk, I wouldn't be wearing a mask. I wouldn't be sitting here. I'm not going to put a mask between me and you guys if you think there's any kind of risk. That doesn't make sense. I'm still taking another question from online, Jason Gale, are you there with your question? Hey, Jason. Hey, Jason. Hey. Hey, Bruce. Lots of feedback, so I will push ahead.


You mentioned learning more about the natural history of this disease these days. How do you how do you think it typically starts to manifests? So it that's a good question, but as one speaks to people, what they remember is the fever, of course. And and in 88 percent now. Now, the nice thing, China's 55000 cases and data on every single one of at the time at onset and what they report is 88 percent say we had fever, 68 percent say they had a dry cough.


And that's important numbers because, folks, what percent have a runny nose throw gas out there. Because, you know, you always see people going out sniffling and the rest of you are owed. They have covered 19, 4 percent. You know, it's not it's not an upper respiratory tract infection. So but Jason, sorry, back to your question. So they report that or the report just a couple of days before having what we call prodromal like syndromes.


They feel fatigued. They fight feel of my ALGEO. They feel unwell. You know, it's just a general on wellness. So part of this is having a high index of suspicion if you think you've been exposed to someone because because they they they they either present with that fever, dry cough or that prodromal, nonspecific malaise, you know, aches and and fatigue. Is that cover, Jason, Jason? Actually, I wanted to ask you what.


What's causing that ammonia progressed to acute respiratory distress syndrome and multi-organ failure? What do we know about that?


That was interesting because a couple of places had documented the data fairly well. It's not published yet. But what it looks like about 80 percent of these are, as I mentioned, mild at time of detection, about 13 percent severe and about 6 percent in critical condition. And then if you look at the present that progressed from one to another, about 15 percent seem to progressed from Mitt, mild to severe and then from severe to critical because I thought it was a higher percent, but it's about 15 to 20 percent.


Again, Jason, that's what those numbers looked like. And then if you look at the survival rates per group, that that's pretty well published. Right. Extremely high in the milds. And then I'd have to pull the numbers out. But the high mortality obviously is in the severe as in especially the criticals. And here you have to be careful, right, because people say, well, what proportion of severe and critical survive and you know. OK.


So say it's 80 percent in Chinese facilities or 90 percent. That's not what it's going to be in other places. They're really good at managing really complicated disease on big scale right now. So I would not have a false sense of security in the numbers.


Okay. One more on line. Tammy b_b_c_, I have. Hello. Go ahead, please. Please me. I don't know if you can hear me. I would like to know what is your response to riskier and riskier Miles? Low tellings, low Spanish fare better than people who are infected. And two hundred and seventy miles an hour, in fact, really dead. Completely dead. We didn't quite get your question was said something about 250000 really bad or 200.


Could you kindly repeat that one? That one, that one.


What is your response to Miles Blo telling Steve Bannon that millions are invited and two hundred and two hundred miles apart? Surely dead that that.


Yeah, I think I am. Tell me I've not seen whatever you just referred to. So again, not dodging a question, but I simply don't know what I'm responding to either. Two people, one of them said it. There's a million case and two hundred and fifty thousand dead and being hidden in China or something like that. Yeah. Yeah.


You know, I didn't go to every single place and every corner of China. But I think we have a pretty good sense of what the epidemic looks like. And I think these numbers are reflective of that.


I did, but I don't know where their information comes from and again, this comes back. You know, I get asked a lot of questions. Well, what about this? What about that? I've got to go with the data that we say. And anything that I told you, we tried to use multiple data points to try and observations to try and corroborate it. Right. We didn't try and go like, oh, we heard that from someone.


Let's go with it. We everything in the team. Remember, I told you is on this team, CDC and I hate Robert Cock. You know, demand stops, institutes, etc. and they'll sign off on this thing. So they're pretty rigorous.


Okay. Okay. Questions from the room. You gotta let me ask questions. Okay.


All right, Jamie. Hiding behind. Am I not allowed to do that? Thank you, sir. No echo on this and hopefully a couple of things. If I could. You mentioned that the science is evolving very fast in China. One of the things that's come out recently is that there may be an oral vaccine in in in in preparation in China. What do you know about that? If you could also tell us about how the two treatment trials are going on, particularly the HIV combo drugs with RIM disappear.


And then just also in the numbers that you've come up with, Doctor, are the director general. Tedros yesterday mentioned to us that there was a seemed to be a disparity in the mortality rate between Wildhorn and the rest of China. Could you try to explain why that is?


Thanks. Sorry, apartment first was about the question about the oral vaccine. I don't have information on that, but there were parts of the team that really dug into some of the science that was being done. So. So we may be able to find something on that. So so apologies in terms of the treatment trials and the in terms of how they're going. Kirstie's are blind to trials, etc.. Right. So somebody asked me. Oh, great.


Talk to childen. How's it looking for him? Desert here? It's a blinded, you know, double blind trial.


Well, I don't know. But what I what I was interested in talking to him, Jamie, was how are you doing on enrollment? What's the timeline to get to your in term numbers where you could actually look at this and the results? And they they as you say, the enrollment had slowed down. There's two different remedies or trials and slow down, but that button is still enrolling. So because, you know, it's urgent, we've got us get answers to outstanding questions, super-fast, because if this drug saves lives, we need to know that.


And so one of the conversations we had in China was, well, how do we prioritize enrollment for the trials that are the most promising? And then how do you make that decision? Because, you know, there's corporate interests and everything else behind these. But but going well, I mean, the amazing thing, remember as well, I mean, you've seen the pictures of Suhan and folks are in there running multiple clinical trials and similarity on the HIV ones.


There's if I remember correctly, some groups have already released some information, but very careful as well. These trials are designed to get answers as quickly as they can. And you know, if if we mandoline answer, ask the wrong questions, etc., you know, we want to know, is there any way we can help you get to the answers you want faster? And clearly, recruitment was what it was, was one area. It's a great story, right?


Most people are getting sick. But on the other hand, we may not get this answer.


Your second question.


Oh, yeah. Winds higher. Higher mortality rate. Right. Yeah.


So there's there's there's there's a couple of things that probably contribute to that cause. One is temperature. Well the three things would contribute 2 to the difference, AVC. The first is it happened at a different time. You know, witchhunts started fast and early. People didn't know we you're dealing with or learning how to treat this from. Remember, they've been through six different treatment guidelines, right? So some of that high mortality you seeing as the first couple of treatment and guidance when we were learning how to how to do this.


The second thing was just the sheer scale of the numbers. And this is specialized care. So, so so that could have been a challenge. But the third thing and this goes back to the point that Helen was making, that at the beginning of this outbreak, remember, people were finding severe disease and that's why the alarm bells went off. And so we're really were sometimes looking at it because we were getting more mild case. It now as knowledge of disease goes up, when we're trying to gather and people are understanding, you got to isolate the mild disease as well.


They can't stay home. That's what's fueling that's the fuel that's keeping this thing going. So you're the mild cases in any more sight on those and that's, you know, broadening your denominator. But one important thing I want to highlight, folks, is, you know, I've heard it say, oh, the mortality rates not so bad because, you know, there's actually way more mild cases. Sorry. The same number of people that were dying to still die.


Yeah. And if that was a problem and a concern, that is still a big problem and a concern. We have to be careful how we interpret it. And these numbers sometimes.


Okay, one more from the room. This lady here? Yes. Of my family. Yes, a sabbatical for Spanish sentence. After all, you have flown in in China, which appears to have appears to be very impressive. How do you explain, for example, what is happening in Europe? The rapid spread of the disease in northern Italy is after it won most of the declaration by W.H.O.. They were not ready. To manage a situation like this.


And what because at some moment is that that work is not really prepared for this. What did you mean by that? What do you mean by that? And. If you could advise five steps to country, whether they have to have participation. What would you say? OK, so.


So first, I'm going to be very careful. I have not been in any other country that's been managing this thing and I don't want to make judgment calls.


And again, there's I would really want to stick to where we've got data and what I what I know happened. So. So I don't know the circumstance about other countries, but I think there's really important lessons from it already. Right. Is and this is happening in northern Italy where you've gotten good systems and you saw the action that they took. Right. I mean, they're acting on scale to try and manage this. I don't know the details of it, so let's hope so.


I don't want to go beyond that. But the this tells you what this virus can do. And I think, you know, I keep saying, OK, well, this happens on that boat. Well, this happens in Korea or that happens there. And I keep hearing people saying, yeah, but that was because of this or. Oh, yeah, that was because of this. I mean, you know, this virus will show up.


You have to think so. You know, in terms of the steps, number one, I think the virus is going to show up tomorrow. You know, like like think like ele-. You know, they're going to find that they think it's gonna be there tomorrow. Right. You're at an incredibly interconnected world.


There's a fantastic paper came out a couple of weeks ago which showed the spread of this virus in China compared with I remember correctly. Was it the 2009 flu pandemic, which was only 10 years ago? And if I remember correctly, every province with this virus had been hit in 23 days with just 10 years ago. It took 120 days or something like that for all of the province. So we're just so much more connected. So you gotta think it's going to be here to more.


If you don't think that way, you're not going to be ready. So first thing is that mindset shift and then you gotta think is if it hits us, we're gonna stop it. You have to think that way. And I keep hearing, you know, this of it hits us. We just have to accept, you know, you've lost before you've started. So, you know, there's that mindset shift. The second thing is, if you're planning to get be ready, you know, you know, you're going to need beds to isolate people.


You're going to need to be able to quarantine the really close contacts because we know you don't 10 percent of those are gonna get disease. So and we know that they may not even know it at the beginning. So you've got to be able to accommodate those people. You have got to have enough ventilators for the serious cases. You have got to know how you're going to transport people to those places. Right. Because you don't want to be managing this in many, many different parts areas.


You've got to have oxygenation or ventilators I mentioned.


You've got to have the lab capacity to be able to do this. You know, China is testing tens of thousands of people every day still for this thing. So it's big time lab capacity and it's not an x ray. They don't do X-rays of these people in China. They C.T. scan them because on a C.T. scan, you can find disease that you can't find on x ray. You know how many of our countries have got C.T. scanning about how many people can we get through a C.T.


scanner, you know, like 10 in a day. China put 200 people through a C.T. scan or in a day. Right. I mean, they have systems to make it work. So you've got to be ready. Hopefully you'll never use that. Right. But if you're ready to do that, you're gonna be ready for an awful lot of things. But it's a readiness and rapid response capacity. So then someone's got to know how to investigate one of these cases.


So do you have 100 people who know how to fill out a case investigation form or a thousand, you know? Or is it going to be looking at that case forum the day that they get that first case? Do you know where they're gonna send that form? You know, who's gonna go talk and try and contact race because that's really hard. So that's, you know, readiness for a rapid response. And but it's you know, when you break it down, every one of those super doable.


Right. The other thing is talk to your population, folks. We have to be ready as if this hits us tomorrow. So everybody wash your hands all the time, right? Don't make a run on the masks because you know what probably doesn't make a difference without that may change over time. But we need him for the response we need and for the infected areas. You gotta get your gear where you need it. Right. And you gotta get your population.


They got to know you're taking to take care of them. Otherwise it's not gonna it's a huge big piece of for me, that would be number three. You know, the fourth thing is talk to people who have done it. China have done it. You know, and we're building barriers to the people who know how to do this.


That's. I'm sure I'm sure there's more. Okay, I'm going to take two on line and then we'll go back to the room. Can I that we have a correspondent from New York Times. Are you on the line?


Line? What about Angola, Angola, Angola, Angola and. Hello. Hello. Summons. Someone speaking? Is somebody there? Hello, New York Times Times Times Time, my question is about anybody.


Anybody, anybody. If you could talk a little bit more about when that was in my room and what the strategy energy or when China is going to start to think three and who they are testing. Testing. Hi. I think there was an at the time, is that right? Covel at the time. So the antibody test was licensed within the lab. I don't know exactly because it was in the last 48 hours I heard it as I was leaving, actually.


And then I started asking some of the virologists who were with us, OK, how did they actually validate this? You know, what is your control pound versus your others rest? I want to know a little, little bit more, because that kind of tells you, well, where is it really in in the process? But so I'd heard that to relicense. And this is something I can validate.


So here I am speculating. I heard there were two hour conversation always with China was about, okay. You need to age stratified zero epidemiologic surveys. China know that as well or better than I do. And what you're trying to do there is understand for each segment of your population, what did the antibody levels look like? That gives you a sense of how much they've been virus may have been circulating there. And for some areas, this becomes really important to to help you think, for example, about opening your schools so our children all zero positive, suggesting that they played a big role in transmission and we missed it.


And Helen's right arm wrong.


And as a result, you should be more careful or take your time on opening the schools, etc. you that would that would help understand that. So there's a number of ways you would use it. And, you know, I don't know how China plans. It's not something that we discussed to roll it out. But I would expect that they're going to want to look at a high intensity transmission area like Wuhan to try and understand. Okay. Because that's where you're gonna get the most information about the extent of it in that setting.


And then you look at it in a lower intensity transmission area. So and the way they kind of see the country is places that have no disease, places that sporadic cases, clusters and community transmission. And I would anticipate and if I got your first name right, that they would they would look in each one of those and try and see. But the reality is, in China, you know, as much as people envisage a highly centralized system, the provinces make a lot of decisions.


The provincial CDC make a lot of decisions about what studies they'll want to do and when. So I would imagine once this is out, there will be a lot of won't restart. A lot of it will be at the the provincial level. But but but again, I'm I'm speculating because I heard that and I think best thing to say is Bruce said he thinks maybe there are and then we try and get the right answer because I've spent the last day on airplanes.


So hopefully that helped. The. Okay. Given the feedback problems, I think would just take two more from the room and then everybody has arrests, needs been sitting here quietly putting up with.


Hi, Bruce, it's Nina Larson from the FBI. I was wondering on your mention of the mortality rate in China that it might be higher outside of China if you could say a bit more on what if there's any evidence of that and how how bad do you think it could be? And also on different parts of the population you mentioned, children don't seem to be affected. But you said there are young people dying. Do you have some some sort of overview?


How many young people are dying from this? And do you think that would be worse outside of China with a different type of response? So on the first question and it's good to hear back, you said this because then sometimes it's OK. I I didn't communicated like clearly as I would like to. So in terms of why the disease, there could be more mortality associated with it if I got the question right. First of all, out outside of these areas of China is China have gotten really good at managing the disease.


And what happens, as you've seen in some of the areas been hit more recently, the early cases you're getting, a lot of the severe cases are coming in. So you kind of get this artificially high rate because it's severe cases and the mild cases aren't getting found. So, for example, in Italy, we know, you know, it's been horrific. I think eight people have died at I'd heard something like that. And, you know, people will immediately start doing the numbers.


But what's happened is it's been these severe cases that are really getting the attention. And so you have that phenomena. The second phenomenon people have. So they're coming much later as well to two facilities. So even if you're severe already severe versus late, severe is a different ballgame. And so people are coming quite late when they're really in serious respiratory distress. And then it can be more difficult. The second one of the other things that concerns me is we have an older population, remember, as well.


Right. And this hits older populations and populations with a lot of co-morbidity. We have a lot of heart disease. We have a lot of hypertension. We have a lot of those diseases that we know are associated with with higher mortality. So there are a number of things that suggest that, you know, you could have bad outcomes initially with this until you really get the hang of it, how to manage these. The other thing I worry as well about is, you know, the question you were asking earlier.


Are we ready to manage these people? Are we thinking, have we studied this? Do we know the disease? Right. This is not flu. This is, you know, a more stars like path of physiology, it looks like. And so are we ready to manage that? So. So those are the things that concern me. And you're one of the big things I want to come back with was really that message of go after the transmission of this thing, don't you know, accept this inevitable sense of inevitability that you cannot control or contain this virus.


And I think Dr. Tedros, you know, can I him saying this a lot in the early going? I think he had an intuitive sense that this was the right thing to be doing. And certainly what we saw would definitely, definitely support that.


And I also worry when this gets in to lower capacity, lower income countries. Right. Don't have ventilators, don't have isolation capacity, don't have oxygen supplies. I mean, those are the things that you need to to keep people alive. You know, it's a gift. So the question of young, young people and how many are dying? This was you know, it's the it's it's low, you know, very low single single digit stuff. But what what worries me on that a little bit is and I talked to a lot of clinicians and said, OK, we know about the older population, we know about the corporate bodies.


This population between 30 and 60 and especially the younger ones when we see people die. What's your gut feeling like? Why are some of these progressing? And, you know, I said we have loved smoking and China. These are heavy smokers. Right. If they got this. If they got that. And no, they didn't. It didn't seem too. And they couldn't identify things. So that makes you uncomfortable, right? What? Well, you because you don't know, you know, where that nail needle in the haystack.


So you've got to manage the whole thing both to keep the community safe, but also to be able to try and predict. It really seems the co-morbidities at an age are the big predictors. But but it's a really important question. And, you know, we've even had very, very young people die of this. By the way, I mentioned something earlier about the human side of this. I remember the mayor of Gwang Jo. 25 million people in the city or something.


I mean, that. Unbelievable. This giant city, he was presenting what they were doing sitting. He's going to slide after slide after slide. And you have phenomenal understanding. You talk around all the issues that the political leaders knew, the disease. And then he popped up one day, said, and this was our youngest survivor, you know, two month old who actually survived this. This disease. It's important to remember it does he had all ages it and can, and then he went on the next line and they said he went back and he said, actually, I want to tell you about this.


He said, you know, this was a family where, if I remember correctly, the whole family, all the adults had become affected. And there was this child, this 2 month old, and they rapidly go and they isolate people. Right. And here's this two month old child, because the grandparents were also affected. And when they took the child to the hospital, it was a close contact they have to do. Your assessment was separate from the mother.


The nurses found a note inside saying, you know, this is my child. She's two months old. And, you know, please make sure she survives this or something. But a baby is just the most heart wrenching thing. And there's millions of million. So many stories like that. And yeah, and this team of nurses took care of this little child and she survived. So on that note, I buddy and I think last question, but what would you know?


I'm happy to have questions yet multiple people have waited a long time. Okay. Yeah. I'm just worried about people's deadlines. But if you're happy to take them, we'll keep going. Yeah.


Nice to see you. Well, Ebola seek yellow fever.


You're in China. Is that Chinese found easier or faster? Taste tomatoes. Because you're just a boy from so on. You have been not isolated. And not. So I think you have another method for fun. Either way. And another question for I remember your question, folks.


I'm not a contact. You know, I have not contacted in any way or been near anybody with Ebola. Ebola.


With with this disease covered. So you don't isolate you isolate cases. Let me be really clear. A case isolation, contact, quarantine, you know, or self-monitoring if there are low risk.


But it's not. It has to be differentiated. So sorry.


I just want to make sure that the other made tomato to work for testing. Have the Chinese funded it for any only instead of in love? Do we have to test the paper? Test the paper for just fine. Or disease were affected. Do we have the some? Either way to do so.


So there's a bunch of work going on in China and elsewhere to to develop rapid diagnostics for the disease. I guess people have heard. Is that what the question is? Yeah, and there's a number of challenges to it. And there's there's four or five different approaches being taken. And because the PCR takes time, takes 50 gated lab, et cetera. And, you know, if you got a rapidly moving outbreak, it's a good question. Is a very it's a bit labor intensive, takes a bit of time, et cetera.


And we've seen lab capacity even in China, where there now can process huge amounts of this as a problem. So right now there there is not a rapid diagnostic, but it is one of the one of the priority development areas.


And you say, oh, I found the war. You said, oh, China, what's. Tuke are aggressive 4 1 with sixes, and you suggest that this is a method to other countries. Oh, yeah, folks.


Time is everything in this disease, right? You've seen the doubling time of the cases, the exponential growth. And I remember, as someone said, there was a study that said some of the big population restriction movements in China had delayed, you know, some areas and spread by 3 days.


And I saw some kind of cynical comment on that or by a week at most. But again, when you look at these curves. Right.


If you can slow something down by 3 days and then affect it like that, by the time you get to a fifth generation of cases, you can cut the size of that by 90 percent days, make a difference with a disease like this. Okay.


It's too late.


He said you fast and then you have seran taken too long with my answers. Thank you very much for taking my question in and giving you a list of my you're a Mexican journalist. I'll say so in this is not an Ebola outbreak where you just knew. We know that. But is there any especial recommendation on the handling of that? There's bodies to have something to say about that.


Think I'm not an expert in that piece of it. But if I remember correctly and the technical guidance we actually have, that's part of the technical guidance series that's available on our Web site. There's a specific recommendation about how one actually goes about that. And again, is not Ebola. You're absolutely right. And we always look at first for everything like that. Is there evidence that, you know, mishandling bodies have resulted in transmission chains, et cetera, wasn't something we're specifically asking about.


But I have not I haven't heard that. So. So it's a different level of risk compared to it. But but I want to be careful because, again, it's not something you looked at. And I'm not an expert on that area yet.


I will be tomorrow.


Thank you. From one U.S. agency doctor already mentioned yesterday that China has adopt all of government. All of society approach to fight the virus. So could you elaborate on this approach to your knowledge? Which part of it or to what extent this approach should be replicated or can be replicated in other countries with different house governing systems and was different capacities in response to this disease? And could you also how do you view the effectiveness of the TCM, the traditional Chinese medicines on the virus?


Please. Thank you. We take the segment first because again, not having worked in China for 25 years. And, you know, I I don't know traditional Chinese medicine well. And it was a striking thing for me just how prevalent the use of of TCM is, but also how organized an awful lot of it as well as and and regimented. And I can't speak to the efficacy of it because I know we didn't see trial results and there weren't randomized trials with it.


So most of the use of it was observational, you know, like they took all the patients. Everybody got TCM because part frankly, of the tree. I think 90 percent of treatments are patients get get some TCM. So it's used a lot. The physicians have a lot of confidence that it helps, particularly in the mild cases. They think that a lot of that is possibly the anti-inflammatory effects of it. Or maybe a._p Radic, you know, helps bring down a fever.


Again, I don't know what's in the compounds, but but that that's what we heard a lot. But again, it was observational data not randomized. So it would not possible to make a judgment one way other than that that regard, but very popular. And and the other thing a couple of physicians said to us that taking TCM helped with a lot of the anxiety around the disease for people as it was part of what they were familiar with, that's et cetera.


So so we heard a lot of positive about it. And it's very much part of I think it may even be in one of the treatment guidelines. I can't remember about how one could use it, but it but I may be wrong about that. So in terms of the all the government, all of society. So I didn't say that. And I never do. If I said it yesterday, that was very, very tired because I never know what that means.


It's like, OK, everybody should do stuff. Everyone should do it. Right. And that's why what what I tried to be careful with my language today and say, you know, it was a repurposing of the machinery of government to run this response. You know, because when we say all of government, everybody should be involved, OK? I normally do agricultural, do more agriculture. I normally transport, do more trains. I don't I think it's a great term, but we use a lot.


And I hear it a lot in responses where that don't look much like this. Let let's say that. So. Yes. So what I heard. Know what I saw in China was that a task force, things had to get done. Which ministry of actually got that kind of machinery or have gotten that kind of transport capacity or got, you know, this kind of capacity. So it was really and where it had to be. I used the term repurposed actually to do to do that.


And then in terms of the all of society, again, I struggle with what that means. And now I'm going to get slaughtered by another part of that village.


Joe, I'm sure they will be there. Great terms, but you got to define. OK. What part of society is actually doing what? And in China, it's really clear. Right. Okay. Everybody has to do this. We need folks doing this. But everyone has to be involved. Because if everyone's aren't taking their procedures, everybody's not cooperating in the lockdowns. Everybody's not doing this. It's not gonna work. Now, of course, there's gonna be slippage in places in terms of can that be replicated elsewhere?


Again, it comes back to, you know, the whole point in this conversation is there's this disease spreading. People are desperately concerned about it. There's evidence from a part of the world that you can be masters of your own fate. Here you because I'm getting this sense that, you know, we've lost that ability with this virus. And China wouldn't accept that and hasn't. And that was that that was the big message cannot be replicated. Why not?


You know, people say, oh, well, we can't do this here. China did it. Well, sorry. Yesterday you said there was no answers. They had to throw your hands up. I mean, come on. You know that. That's how I try, because nothing on that list that you asked me, you know, how to get ready. Well, do one, two, three, four.


There's nothing on that list that countries can do that. It's a great place to handle.


Question. Sure. Oh, no. I think that's. You've got one more. Okay. Okay. Last one because. And I have to apologize to people on line with not being able to maintain the line. There was a question about the reports. Yeah. Whether whether it will be available and when. Okay.


So my job is to write the report. Well, actually, the team wrote the report. And again, it's a little embarrassing because I've said I did this or we did that and people have said what I thought. I want to be really. Here, everything that's in the report and everything that we're saying are things that were carefully discussed with 25 people and a consensus view on. So it is not me as an individual providing a perspective. The other thing was we kept this completely separate of W.H.O.


in degree possible of the government, China and of the people who were on the mission from their institutions. They were serving there their capacities as deep experts. And I have to say, you know, as the journalists that were looking for me more than my own organization was badgering me.


And I appreciated that, as did this team, as did the team members. But it was just so important. You know, this is 25 people who know this business in different parts of it came to this conclusions collectively. And there are things that aren't in the report. Now, you're gonna ask me what? I'm sure there's lots of areas where we didn't think there was enough evidence that supported and it's not there. But most people were struck by the big picture.


Right. The curve doesn't have to include all those people that we we we we talked about.


You reminded me the other thing, the other ask online. I heard when people get hurt. Can we post them when we have to wait for the.


These belong to the governor. China will. We'll we'll try to make sure that. Well, when the report comes out. Oh, someone asked about about the report. So the report goes to Dr. Tedros, goes to the government of China and it's going to them tonight. And then they will be in charge of a release. I would anticipate that they're going to want to read it and absorb it, because I'm not speaking for W.H.O.. I'm speaking for an independent team of experts and W.H.O.


. I will brief W.H.O. tomorrow and then they will make their decisions about if and how they want to act on this.


And last question. Good afternoon, Dr. Bruce. Outright. Actually, first my first my first question was about the report as well, that you have a ready answer. So I move to the second one. That's the outbreak of Kavita, 19 has been going on for some time. So people may enter a period of psychological fatigue. In your opinion, how would you better soothe the anxiety of people? And meanwhile, from what you have seen, do you think?


Do you think that in the face of this epidemic, China, W.H.O. and the whole world has more experience and preparation? Thank you. Yeah. So the second question is easier. There is a lot more experience. You know, I did have a couple of people on my team from W.H.O., including the technical lead from from W.H.O.. We do have a country office there, of course, in a regional office which is rotating people through such an increasing, you know, knowledge and experience of what China's done and how that can be used to.


Part of my role is to say, here's what we said and try and get this out to to to others. So. But again, it's still a very new disease. And we're all learning and we need to be very careful. This is what we know today, tomorrow. Can, can, can, can look a bit different. But this looks pretty robust, right? They've been doing this for four weeks now. And the first question was.


Oh, yeah. Anxiety really important. Interestingly, and a number of people in the team commented on this to me. All of the clinicians that we talked to and the people running these big facilities, whether a stadium or hospital or whatever, they all talked about how they take care of the patients, the medical needs and the rest, and how they take care of the. The psychological needs of the patient. And then there was also a lot of discussion about the people who were in quarantine, the very close contacts who were at the high risk law to talk about the psychological support for them.


And then they were also running hotlines, but they had this was as big as the medical part of the response was. It was the impression that that one got at a German general public level. Right. They want to know, is there anything that we can do? Yes. Are we ready to do this? That's what they want to hear from the leadership in their countries. And that's why we want to get the message out. And and hopefully, hopefully help that, because, again, I come back to that point, that is concern me a little bit.


That sense of helplessness in the face of a virus. Right. It's 21st century and science's is incredible on this. And, you know, we've seen a country take a war footing to try and use really fundamental principles in the absence of a vaccine, absence of drugs and turn this around. But it isn't going to work as well unless the population is highly sensitized and and because you got to find those early cases fast. And if you wait for him to come to a hospital, remember, people are asking about wolfhound.


I think you you were asking earlier. But, you know, the average time from onset of symptoms to a when they were admitted and hit the hospital when this started in the first period, if I remember correctly, something like 15 days. So for 15 days, that person is out there with a reproductive rate or two of the virus interacting with people, getting sicker and sicker and interacting with more and more people. So this thing is spreading and moving.


So you've got to cut that right down. And in China's three days now from when someone starts to get sick or when they get him isolated in a hospital bed. Right. So they're cutting down the number of people that are getting exposed. And that's why the cases are dropping fast, because at a certain point, you choke off the ability of this thing to find susceptible. So coming back to your issue about the the anxiety. People want to know what is this thing and they want to know.


You know, I have a family. I know. What is this thing? Is there anything we can do about it? Are we ready to do it? You know, each of those questions, there's more, more answers. The big question that remains is, are we ready? And, you know, no. And someone will ask me, OK, well, when will we'll be ready. You'll never be ready. The day that you think I'm ready.


Now, you're you're you're not ready. Right. Because you got to have that sense of it's going to come here today. OK. I got this place that in place. That in place. You never feel completely ready. Right. Me getting on a plane to go to China, do that. You ready? I know how to spell it right. No, not quite.


But, you know, and that's Siri there, the reality. But you've got to be as ready as possible. And we're not as ready as we could be first. Psychologically, you know, our mindset and then in the materials and then the population's got to be with us. There was one other question behind that I said, of course. I think had. Behalf of the ICRC, I would like to know if there is a spread of the Corona virus in conflict affected areas, even in developing countries.


How can states? SIEGEL So say the NGOs, international organizations respond. Thank you. It's a great, great question.


Premi Oh, okay. Some from the press when asked the question.


Now, but but this is this is this is what you know, and I'm not speaking as a W.H.O. person. That's what I know of Tedros. You know, this is what keeps Dr. Tetris awake at night is when these things hit, you know, low income countries. He knows the reality of Africa. And for those of, you know, no doctor territories, I mean, he's incredibly human person. And he worries about this and he feels a tremendous responsibility that, OK, you know, what's our first and second level line of defense while we try and get better prepared to be able to deal with this in places that don't have the capacity?


That's why I went to China. China, you're gonna be the first on that wall of defense against this thing. And they took it seriously, very seriously. And now it's in Europe. We've got escalating outbreaks in industrialized countries. And. And again. You know, you're the second level of defense here. You've got to you've got to try to respond because. And then at the same time, the work on the vaccine, the work on the therapeutics, though, you know, has got to continue really outpace the rapid diagnostics and get these people isolated like you were asking earlier and faster.


And by the way, in the report, that's one of the recommendations. I didn't go through them all. But, you know, we had four big observations about China, which was about, you know, the the four big things were there about, you know, the strategy, the impact that it had, the next steps. And then there was one other big piece. And then on the on the other side about the rest of world was about the virus.


And my my first point on the viruses, this is not SaaS or flu. Don't get stuck thinking one way or the other. You got to keep, you know, your options open here. And I could be wrong exactly one of my hand. But but I won't be. Then the second big piece and third big pieces we've talked about. But the fourth piece was about collaboration. Right. What you're trying to do, get ready and try and buy more time.


But the next pieces use the time you buy really, really well. So, you know, I said we're not ready. But the other thing is, we're not using the time. We're trying to gain well enough either. OK. This is the time for the Manhattan projects, right? This is the time when. OK. You want to get vaccine against this. You get the countries organize together. You run multi-country trials if you have to, cause you haven't got enough patients in any one trial.


But you want a Manhattan Project on your top vaccine candidates, you want a similar approach on your top therapeutics. You should not be struggling to get patients into trials because to your question and thanks for asking. Those are the things that are going to help in those settings. Some of the traditional strategies can be applied anyway, but it's going to be easier with better tools. Use the time. Well, get ready. Get the right diagnostics and therapeutics.


The other thing is do the right studies. Like when you ask people about when I was going to. People heard I was going to China. I got lists of studies as my arm epidemiologic. So serious I got it for everybody in the world and people you know well.


And it's just as bewildering a way, Ray, to somebody. You know, I work in this area and I'm bewildered by them all. Why are we doing that? What about this one? Get organized. There's three or four. You have to answer. You need household studies. Understand the secondary spread. It need zero assays to understand the immunity in the population. Right. So there's three or four have to haves get organized. So use the time that you're trying to buy.


Well, because it's going to save lives. Yeah. Last point, despite what people think, right? Sometimes research saves lives. You got to do that as well. Thank you very much.


That is an excellent last point. Apologies again to all the people online that we couldn't get to you, but also because of the feedback that they've technical difficulties. It was impossible. If you've got more questions, you know, to come to media inquiries and as you know, ductile with is extremely generous with his time and his thinking. So I hope we'll be able to answer anything that's been left behind. And thank you all again for attending.


And thanks for my side. Folks, I'm sorry it took a long time answering these questions and so many of them. But, you know, you're getting me right off the plane. So it's not media bias, right? I'm just I'm we're we're trying right now to distill this. And part of it is we're doing it with you.